The Future of Hormone Therapy

         You might have known that menopause is when a woman loses her menstrual period but did you also know about the other symptoms associated with menopause? Menopause is a routine part of life for women that occurs in their forties or fifties. After menopause, the ovaries stop producing hormones, and it has been a full year since the last menstrual period. Menopausal symptoms can be cognitive and physical in nature. This includes hot flashes, stiffness or soreness, difficulty staying asleep, and a decrease in verbal memory. Although these symptoms are not experienced by all women, they can be very bothersome for some. So how can these symptoms be mediated in women who experience them extensively?

        In the article, Hormone therapy for first-line management of menopausal symptoms: Practical recommendations, Palacios et al. examine the history of hormone therapy use in regard to menopausal symptoms, discuss the current state of hormone therapy, and provide recommendations on hormone therapy going forward. Prior to the early 2000s, particularly during the ‘80s and ‘90s, hormone therapy use was at a high. However, a study in the early 2000s showed possible adverse side effects, including stroke and an escalated risk of breast cancer. This caused a reluctance in physicians to treat symptoms with hormone therapy because they believed the risks outweighed the benefits. Consequently, the use of hormone therapy fell dramatically in subsequent years.

Recent studies, however, have shown that the study from the early 2000s may not have been entirely accurate in presenting the risk factors associated with hormone therapy. Palacios et al. propose that hormone therapy, in conjunction with other measures such as the termination of smoking and increasing physical activity in women who present moderate to severe symptoms would work best to prevent chronic conditions associated with menopause. In addition, pre-existing conditions, such as diabetes and obesity, should also be taken into account when considering hormone therapy in order to properly assess the risk-to-benefit ratio. 

In the article, Perimenopausal use of hormone therapy is associated with enhanced memory and hippocampal function later in life, Maki et al explored the effect of hormone therapy on verbal memory in postmenopausal women. Half of the women had started hormone therapy in perimenopause and the other half had never used hormone therapy. The researchers discovered that the women who had started hormone therapy at the perimenopausal stage performed better on the verbal memory task. These women also showed increased activation in the left hippocampus, which is associated with better memory performance. The study supported the hypothesis that there is a critical time frame when it comes to initiating hormone therapy.

Hopefully, further studies can shed more light on how to treat menopausal symptoms and the underlying brain mechanisms associated with hormone therapy use.

References:
1. Palacios S, Stevenson JC, Schaudig K, Lukasiewicz M, Graziottin A. Hormone therapy for first-line management of menopausal symptoms: Practical recommendations. Women’s Health. 2019;15. doi:10.1177/1745506519864009

2. Maki PM, Dennerstein L, Clark M, Guthrie J, LaMontagne P, Fornelli D, Little D, Henderson VW, Resnick SM. Perimenopausal use of hormone therapy is associated with enhanced memory and hippocampal function later in life. Brain Res. 2011 Mar 16;1379:232-43. doi: 10.1016/j.brainres.2010.11.030.